Anemia in Pregnancy

What is anemia?

Anemia is when your blood has too few red blood cells. Having too few red blood cells
makes it harder for your blood to carry oxygen or iron. This can affect how cells
work in nerves and muscles. During pregnancy, your baby also needs your blood.

You can get several kinds of anemia during pregnancy. These are:

Anemia of pregnancy. In pregnancy, your body makes more blood but keeps the same amount of red blood cells.
This is sometimes called anemia of pregnancy. It is not considered abnormal unless
your red blood cell count falls too low.

Iron-deficiency anemia. During pregnancy, your baby uses your red blood cells for growth and development,
especially in the last 3 months of pregnancy. If you have extra red blood cells stored
in your bone marrow before you get pregnant, your body can use those stores during
pregnancy. Women who do not have enough iron stores can get iron-deficiency anemia.
This is the most common type of anemia in pregnancy. Good nutrition before getting
pregnant is important to help build up these stores.

Vitamin B12 deficiency. Vitamin B12 is important in making red blood cells and protein. Eating food that
comes from animals, such as milk, eggs, meats, and poultry, can prevent vitamin B12
deficiency. Women who don't eat any foods that come from animals (vegans) are most
likely to get vitamin B12 deficiency. Strict vegans often need to get vitamin B12 shots
during pregnancy.

Folate deficiency. Folate (folic acid) is a B vitamin that works with iron to help with cell growth. If
you don't get enough folate during pregnancy, you could get iron deficiency. Folic
acid helps cut the risk of having a baby with certain birth defects of the brain and
spinal cord if it is taken before getting pregnant and in early pregnancy.

Who is at risk for anemia during pregnancy?

Women are more likely to get anemia during pregnancy if they:

Are strict vegetarians or vegans. They are at greater risk of having a vitamin B12
deficiency.

Have celiac disease or Crohn's disease, or have had weight loss surgery where the
stomach or part of the stomach has been removed

Women are more likely to get iron-deficiency anemia in pregnancy if they:

Have two pregnancies close together

Are pregnant with twins or more

Have vomiting often because of morning sickness

Are not getting enough iron from their diet and prenatal vitamins

Had heavy periods before pregnancy

What causes anemia during pregnancy?

You can get several kinds of anemia during pregnancy. The cause varies based on the
type.

Anemia of pregnancy. During pregnancy, the volume of blood increases. This means more iron and vitamins
are needed to make more red blood cells. If you don't have enough iron, it can cause
anemia. It is not considered abnormal unless your red blood cell count falls too low.

Iron-deficiency anemia. During pregnancy, your baby uses your red blood cells for growth and development,
especially in the last 3 months of pregnancy. If you have extra red blood cells stored
in your bone marrow before you get pregnant, your body can use those stores during
pregnancy. Women who do not have enough iron stores can get iron-deficiency anemia.
This is the most common type of anemia in pregnancy. Good nutrition before getting
pregnant is important to help build up these stores.

Vitamin B12 deficiency. Vitamin B12 is important in making red blood cells and protein. Eating food that
comes from animals, such as milk, eggs, meats, and poultry, can prevent vitamin B12
deficiency. Women who don't eat any foods that come from animals (vegans) are most
likely to get vitamin B12 deficiency. Strict vegans often need to get vitamin B12 shots
during pregnancy.

Folate deficiency. Folate (folic acid) is a B vitamin that works with iron to help with cell growth. If
you don't get enough folate during pregnancy, you could get iron deficiency. Folic
acid helps cut the risk of having a baby with certain birth defects of the brain and
spinal cord if it is taken before getting pregnant and in early pregnancy.

What are the symptoms of anemia during pregnancy?

You may not have clear symptoms of anemia during pregnancy unless your cell counts
are very low. Symptoms may include:

Pale skin, lips, nails, palms of hands, or underside of the eyelids

Feeling tired

Sensation of spinning (vertigo) or dizziness

Labored breathing

Rapid heartbeat (tachycardia)

Trouble concentrating

The symptoms of anemia can be like other health conditions. Always see your healthcare
provider for a diagnosis.

How is anemia during pregnancy diagnosed?

Your healthcare provider will check for anemia during your prenatal exams. It is usually
found during a routine blood test. Other ways to check for anemia may include other
blood tests such as:

Hemoglobin. This is the part of blood that carries oxygen from the lungs to tissues in the body.

Hematocrit. This measures the portion of red blood cells found in a certain amount of blood.

How is anemia during pregnancy treated?

Your healthcare provider will figure out the best treatment based on:

How old you are

Your overall health and health history

How well you can handle specific medicines, procedures, or therapies

Your opinion or preference

Treatment for iron deficiency anemia includes taking iron supplements. Some forms
are time-released. Others must be taken several times each day. Taking iron with a
citrus juice, such as orange, can help your body take it in. Taking antacids may make
it harder for your body to take in iron. Iron supplements may cause nausea and cause
stools to become dark greenish or black in color. They may also cause constipation.

What are the complications of anemia during pregnancy?

If you have anemia during pregnancy, your baby may not grow to a healthy weight, may
arrive early (preterm birth), or have a low birth weight. Also being very tired may
keep you from recovering as quickly after birth.

Can anemia during pregnancy be prevented?

Good pre-pregnancy nutrition not only helps prevent anemia, but also helps build other
nutritional stores in your body. Eating a healthy, balanced diet before and during
pregnancy helps keep up your levels of iron and other important nutrients needed for
your growing baby.

Good food sources of iron include:

Meats. Beef, pork, lamb, liver, and other organ meats.

Poultry. Chicken, duck, turkey, and liver, especially dark meat.

Fish. Shellfish, including (fully-cooked) clams, mussels, and oysters are good. So are sardines
and anchovies. The FDA recommends that pregnant women eat 8 to 12 ounces per week
of fish that are lower in mercury. These include salmon, shrimp, pollock, cod, tilapia,
tuna (light canned), and catfish. Don't eat fish with high levels of mercury, such
as tilefish from the Gulf of Mexico, shark, swordfish, and king mackerel. Limit white
(albacore) tuna to only 6 ounces per week.

Leafy greens of the cabbage family. These include broccoli, kale, turnip greens, and collards.

Experts recommend all women of childbearing age and all women who are pregnant take
vitamin supplements with at least 400 micrograms of folic acid. Folate is the form
of folic acid found in food. Good sources are:

Leafy, dark green vegetables

Dried beans and peas

Citrus fruits and juices and most berries

Fortified breakfast cereals

Enriched grain products

Key points about anemia in pregnancy

Anemia is a condition of too few red blood cells.

Four kinds of anemia can happen during pregnancy: anemia of pregnancy, iron deficiency
anemia, vitamin B12 deficiency, and folate deficiency.

Anemia may cause your baby to not grow to a healthy weight. Your baby may also arrive
early (preterm birth) or have a low birth weight.

Anemia is usually found during a routine blood test for hemoglobin or hematocrit levels.

Treatment depends on the type of anemia and how bad it is.

Good nutrition is the best way to prevent anemia during pregnancy.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells
you.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.

Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.

Ask if your condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if you do not take the medicine or have the test or procedure.

If you have a follow-up appointment, write down the date, time, and purpose for that
visit.